| Objectives:Gastric cancer was a high incidence malignant tumor,and the mainly gastric cancer was distal gastric antrum in our country.Surgery was an important method to treat the gastric cancer in currently,including traditional laparotomy and laparoscopic surgery.Conventional laparotomy had many advantages such as clear operation scope,accurate excision range,intuitive operation and exact curative effect,but it also had many disadvantages such as greater body trauma,more obvious traumatic stress response,more intraoperative bleeding,and slow postoperative recovery.Laparoscopic radical gastrectomy had many disadvantages such as a light body trauma,rapid recovery of postoperative gastrointestinal physiological function,slight pain,short postoperative hospital stay,and less impact on immune function.However,laparoscopic radical gastrectomy still remained controversial about the radical resection of tumor and lymph node cleaning.Therefore,this study intended to compare the clinical efficacy,immune function and quality of postoperative life of laparoscopic-assisted radical gastrectomy and open radical gastrectomy for patients with distal gastric cancer,so as to offer reference for the laparoscopic-assisted radical gastrectomy in the treatment of distal gastric cancer.Methods:The clinical data of 82 patients with distal gastric cancer who underwent radical gastrectomy for gastric cancer from January 2015 to October 2017 in Jinhua hospital of Traditional Chinese Medicine were retrospectively analyzed.The diagnosis was made according to the electronic endoscopy,histopathological biopsy and CT scan of the upper abdomen before operation.The patients were divided into two groups according to the difference of surgical treatment measures.The laparoscopic group(n=42 cases)was treated with laparoscopic-assisted radical gastrectomy,and the laparotomy group(n=40 cases)was treated with laparoscopic radical gastrectomy.The related indicators of two groups such as operation length,intraoperative blood loss,postoperative defecation time,postoperative anal exhaust time,ambulation time,postoperative hospital stay were detailed record and compared.The pathological indexes such as the distance between the margin and the tumor,the distance between the lower margin and the tumor,the number of lymph node dissection,the number of lymph node dissection in the first station and the number of lymph node dissection in the second station of the two groups were also compared.The questionnaire of patient satisfaction survey was established according to the relevant literature data,the satisfaction of the two groups during operation was investigated.Kiyak satisfaction questionnaire was used to evaluate the aesthetic condition of abdominal incision of the two groups three months after the operation.The visual analogue scale was used to evaluate the surgical incision pain of two groups.Briggs' comfort rating method was used to evaluate the comfort ratings of the two groups.The expression levels of white blood cell(WBC),C-reactive protein(CRP),tumor necrosis factor-a(TNF-?)and interleukin-6(IL-6)of the two groups were detected by enzyme-linked immunosorbent assay.The postoperative complications such as incision infection,pulmonary infection,anastomotic leakage and bleeding of the two groups were detailed record.The levels of CD3+,CD4+,CD8+,CD4+/CD8+,T lymphocytes subsets and NK cells in peripheral blood of two groups before operation and 3 days after operation were detected by flow cytometry.The levels of serum immunoglobulin(Ig)G and IgM of the two groups before and after operation were detected by immunoturbidimetry.The prevalence of subjective symptoms,social function,physiological status,psychological status and GLQI score of two groups before and one month after surgery were evaluated by the Gastrointestinal Quality Life Index(GLQI).Results:There was no significant difference between the two groups in clinical data such as sex,age,tumor size,histological type and TNM staging(P>0.05).The operation time of laparoscopic group was significantly longer than that of the open group(P<0.05),the postoperative defecation time,postoperative anal exhaust time,ambulation time of laparoscopic group was significantly faster than that of open group(P<0.05),and the postoperative hospital stay was much shorter(P<0.05).There were not significantly different between the two groups about the distance between the upper margin and the tumor,the distance between the lower margin and the tumor,the number of lymph node dissection,the number of lymph node dissection in the first station and the number of lymph node dissection in the second station(P>0.05).The level of satisfaction,visual analogue scale,Brinell's comfort rating and incision score in the laparoscopic group were significantly better than those in the laparotomy group(P<0.05).There were no significant differences between the two groups about WBC count,serum levels of CRP,IL-6 and TNF-a before the surgery(P>0.05),but the levels significantly increased after surgery(P<0.05),and the level of laparotomy group increased more than that of the laparoscopic group(P<0.05).The incidence of postoperative complications such as wound infection,lung infection,anastomotic leakage and bleeding of the laparoscopic group(7.14%)was significantly lower than that of the open group(P<0.05).There was no significant difference between the two groups about the level of CD3+,CD4+,CD8+,CD4+/CD8+ T lymphocyte subsets and NK cells before surgery(P>0.05).The level of CD3+,CD4+,CD4+/CD8+T lymphocyte subsets decreased significantly of both groups postoperative(P<0.05),while the levels of CD8+ T lymphocyte subsets increased significantly,and the laparotomy group decreased or increased more than the laparoscopic group(P<0.05).There were no significantly different between two groups about the serum levels of IgG and IgM before surgery(P>0.05).The serum levels of IgG and IgM of two groups significantly decreased after surgery(P<0.05),and the level of laparotomy group decreased more than that of laparoscopy group(P<0.05).There was no significant difference between the two groups about subjective symptom,social function,physiological function,mental state and GLQI score before operation(P>0.05).The activities,physiological functions,mental and emotional state and GLQI score of two groups decreased to some extent after surgery.However,the postoperative decrease of open group was more significant than that of before operation and also more significant than that of laparoscopic group(P<0.05).Conclusion:Although the operation time of laparoscopic group was significantly longer than that of laparotomy group,the amount of bleeding during operation was significantly less than that of laparotomy group.The postoperative defecation time,postoperative anal exhaust time and ambulation time were significantly faster than those of laparotomy group,the postoperative hospitalization time was also significantly shorter than the open group.The postoperative pathological indicators were not significantly different between the two groups.Besides,satisfaction level,visual analogue scale,Brinell comfort rating,aesthetic score,quality of life,and the incidence of postoperative complications of the laparoscopic group were also significantly better than that of the open group.In addition,the effect on WBC count,inflammatory factors and immune function(T lymphocyte subsets,NK cells,IgG,IgM)of laparoscopic group was significantly less than that of the laparotomy group. |
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